State Disclosures, Exclusions, Limitations & Reductions

General Disclosures
This website is designed as a marketing aid and is not to be construed as a contract for insurance. It provides a brief description of the important features of the policy. Full terms and conditions of coverage are defined by and governed by an issued Medicare Supplement policy.

America Retirement Life Insurance Company

Medicare Supplement Policy Form Series:

  • Plan A: AR-MSD-AA-A-GN, AR-MSD-IA-A-GN, AR-MSD-CR-A-GN
  • Plan F: AR-MSD-AA-F-GN, AR-MSD-IA-F-GN; AR-MSD-CR-F-GN
  • Plan G: AR-MSD-AA-G-GN, AR-MSD-IA-G-GN, AR-MSD-CR-G-GN
  • Plan N: AR-MSD-AA-N-GN, AR-MSD-IA-N-GN, AR-MSD-CR-N-GN

Address:
American Retirement Life Insurance Company
P.O. Box 26580
11200 Lakeline Blvd., Suite 100,
Austin, TX 78755-0580

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plan F);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the Pre-existing Conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

Medicare Supplement Policy Forms: Plan A: AR-MSD-AA-A-TN; Plan F: AR-MSD-AA-F-TN; Plan G: AR-MSD-AA-G-TN; Plan N: AR-MSD-AA-N-TN.

 

Exclusions and Limitations

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plan F);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) confinement that begins or expenses incurred while your policy is not in force.

(8) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the Pre-existing Conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

Exclusions and Limitations

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible;

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first ninety (90) days from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least ninety (90) days of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a ninety (90) day waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than ninety (90) day prior creditable coverage, the Pre-existing Conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within ninety (90) days prior to the policy effective date.

Cigna Health and Life Insurance Company

Medicare Supplement Policy Form Series:

  • Plan A: CHLIC-MS-AA-A-GN, CHLIC-MS-IA-A-GN, CHLIC-MS-CR-A-GN
  • Plan F: CHLIC-MS-AA-F-GN, CHLIC-MS-IA-F-GN, CHLIC-MS-CR-F-GN
  • Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-GN, CHLIC-MS-IA-HDF-GN, CHLIC-MS-CR-HDF-GN
  • Plan G: CHLIC-MS-AA-G-GN, CHLIC-MS-IA-G-GN, CHLIC-MS-CR-G-GN
  • Plan N: CHLIC-MS-AA-N-GN, CHLIC-MS-IA-N-GN, CHLIC-MS-CR-N-GN

Address:
Cigna Health and Life Insurance Company
P.O. Box 26580
11200 Lakeline Blvd., Suite 100,
Austin, TX 78755-0580

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans F & HDF);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Pre-existing Conditions:  We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Important Notice: In Colorado, all Medicare Supplement plans are available to persons eligible for Medicare because of disability.

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benfits of this policy and the benefits paid by Medicare may not exceed one-hundred perecent(100%) of the Medicare Eligible Expenses incured. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans F & HDF);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs(except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of creditable coverage; or,if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied.Evidence of prior coverage or replacement must have been disclosed on the application for this policy.If you had less than six (6) months prior creditable coverage,the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage.If this policy is replacing another Medicare Supplement policy,credit will be given for any portion of the waiting period that has been satisfied.A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Medicare Supplement Policy Form Series: Plan A: CHLIC-MS-IA-A-ID; Plan F: CHLIC-MS-IA-F-ID; Plan High Deductible F (HDF): CHLIC-MS-IA-HDF-ID; Plan G: CHLIC-MS-IA-G-ID and Plan N: CHLIC-MS-IA-N- ID.

 

Exclusion and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible; (Not Applicable in Plans F & HDF)

(2) any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre- existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months before the effective date of coverage.

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-MI; Plan F: CHLIC-MS-AA-F-MI; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-MI; Plan G: CHLIC-MS-AA-G-MI; and Plan N: CHLIC-MS-AA-N-MI.

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans F and HDF);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in this policy; or

(7) Pre-existing Conditions:  We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Medicare Supplement Policy and Rider Form Numbers: Basic Medicare Supplement Policy: CHLIC-MS-BASIC-MN; Extended Basic Medicare Supplement Policy: CHLIC-MS-EXTENDED-MN; Medicare Supplement Policy with $20 and $50 Copayment Medicare Part B Coverage: CHLIC-MS-COPAYMENT-MN; High Deductible Coverage Medicare Supplement Policy: CHLIC-MS-HIGHD-MN; Medicare Part A Deductible Rider: CHLIC-MS-PTAD-MN; Medicare Part B Deductible Rider: CHLIC-MS-PTBD-MN; Medicare Part B Excess Charge: CHLIC-MS-PTBEXC-MN; Preventive Medical Care Benefit Rider: CHLIC-MS-PC-MN.

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1a) Basic Medicare Supplement Policy: The Medicare Part A & Part B Deductibles;
(b) Medicare Supplement Policy with $20 and $50 Copayment Medicare Part B Coverage: the Medicare Part B Deductible;
(c) High Deductible Coverage Medicare Supplement Policy: the Medicare Part B Deductible.

(2) Any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) Any services that are not medically necessary as determined by Medicare;

(4) Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);

(5) Any type of expense not a Medicare Eligible Expense except as provided previously in this policy; or

(6) Any Deductible, Coinsurance or Co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) Expense resulting from a Preexisting Condition is not covered unless it is incurred 6 months or more after the Coverage Effective Date. A Preexisting Condition is one: (a) for which medical advice was given or treatment was recommended by or received from a Physician within 90 days or less before Your Coverage Effective Date; and (b) which would not have caused Us to deny issuing Your policy had it been named on Your application.
This provision does not apply if, as of the date of application, You had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least six (6) months. If, as of the date of application, You had less than six (6) months prior Creditable Coverage, the Preexisting Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. This provision does not apply if You applied for and were issued this policy under guaranteed issue status.

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-OK; Plan F: CHLIC-MS-AA-F-OK; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-OK; Plan G: CHLIC-MS-AA-G-OK; Plan N: CHLIC-MS-AA-N-OK.

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans F and HDF);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in this policy; or

(7) Pre-existing Conditions: We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Medicare Supplement Policy Forms:  Plan A: CHLIC-MS-AA-A-PA; Plan B: CHLIC-MS-AA-B-PA; Plan F: CHLIC-MS-AA-F-PA; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-PA; Plan G: CHLIC-MS-AA-G-PA; and Plan N: CHLIC-MS-AA-N-PA.

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible; (not applicable in Plans F & HDF)

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Pre-existing Conditions:  We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

 

Medicare Supplement Policy Forms: Plan A: CHLIC-MS-AA-A-TX; Plan F: CHLIC-MS-AA-F-TX; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-TX; Plan G: CHLIC-MS-AA-G-TX; and Plan N: CHLIC-MS-AA-N-TX.

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans F & HDF);

(2) any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or

(7) Pre-existing Conditions:  We will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:

1) Skilled Nursing Facility Care costs beyond what is covered by Medicare and the Wisconsin mandated 30-day skilled nursing benefit;

2) Home Health Care visits above the number of visits covered by Medicare and the Wisconsin mandated 40 visits in a twelve month period;

3) Physician charges above Medicare’s approved charge, unless the Optional Medicare Part B Excess Charges Rider is purchased;

4) Outpatient prescription drugs;

5) Most care received outside the USA, unless the Optional Foreign Travel Emergency Rider is purchased;

6) Dental care (except anesthesia charges for dental care provided in a hospital or ambulatory surgery center), dentures, checkups, routine immunizations, cosmetic surgery, routine foot care, examinations for and the cost of eyeglasses or hearing aids, unless eligible by Medicare;

7) Any expense incurred in excess of the Usual and Customary Charge or not medically necessary as determined by Us for all required Wisconsin mandated benefits;

8) Any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

9) Any services that are not medically necessary as determined by Medicare;

10) Any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if You were enrolled in Parts A and B of Medicare;

11) Any type of expense not a Medicare Eligible Expense except as provided previously in this policy

PREEXISTING CONDITION: We will not pay for any expenses incurred for care or treatment of a Preexisting Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if You applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy You had at least six (6) months of prior Creditable Coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy.

If You had less than six (6) months prior Creditable Coverage, the Preexisting Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.

DEFINITION

PREEXISTING CONDITION means a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Loyal American Life Insurance Company

Medicare Supplement Policy Form Series:

  • Plan A: LY-MSD-AA-A-GN, LY-MSD-IA-A-GN, LY-MSD-CR-A-GN
  • Plan F: LY-MSD-AA-F-GN, LY-MSD-IA-F-GN, LY-MSD-CR-F-GN
  • Plan G: LY-MSD-AA-G-GN, LY-MSD-IA-G-GN, LY-MSD-CR-G-GN
  • Plan N: LY-MSD-AA-N-GN, LY-MSD-IA-N-GN, LY-MSD-CR-N-GN

Address:
Loyal American Life Insurance Company
P.O. Box 26580
11200 Lakeline Blvd., Suite 100,
Austin, TX 78755-0580

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plan F);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions:  These policies will not pay for any expenses incurred for care or treatment of a Pre-existing Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

Medicare Supplement Policy Forms: Plan A: LY-MSD-AA-A-NJ, Plan C: LY-MSD-AA-C-NJ, Plan F: LY-MSD-AA-F-NJ, Plan G: LY-MSD-AA-G-NJ, and Plan N: LY-MSD-AA-N-NJ.

 

Exclusions and Limitations:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plans C and F);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions:  These policies will not pay for any expenses incurred for care or treatment of a pre-existing condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for this policy.  If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.  A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months prior to the policy effective date.

Medicare Supplement Policy Forms: Plan A: LOYAL-MS-AA-A-OR; Plan B: LOYAL-MS-AA-B-OR; Plan C: LOYAL-MS-AA-C-OR; Plan D: LOYAL-MS-AA-D-OR; Plan F: LOYAL-MS-AA-F-OR; Plan G: LOYAL-MS-AA-G-OR; and Plan N: LOYAL-MS-AA-N-OR

 

Exclusions and Limitations for Oregon Plans A, F, G & N:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plan F);

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if you were enrolled in Parts A and B of Medicare;

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as an additional benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions:  No claim for loss incurred after six (6) months from the effective date of your coverage will be reduced or denied on the ground that a disease or physical condition had existed within six (6) months prior to the policy effective date.  These policies will not pay for any expenses incurred for care or treatment of a Pre-existing Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied.  Evidence of prior coverage or replacement must have been disclosed on the application for this policy.  If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.  A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.

 

Exclusions and Limitations for Oregon Plans B, C & D:

The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare eligible expenses incurred. This policy will not pay benefits for the following:

(1) the Medicare Part B Deductible (not applicable in Plan C)

(2) any expense which you are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

(3) any services that are not medically necessary as determined by Medicare;

(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid);

(5) any type of expense not a Medicare eligible expense except as provided previously in this policy;

(6) any deductible, coinsurance or co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy;

(7) confinement that begins or expenses incurred while your policy is not in force; or

(8) Pre-existing Conditions:  No claim for loss incurred after six (6) months from the effective date of your coverage will be reduced or denied on the ground that a disease or physical condition had existed within six (6) months prior to the policy effective date. These policies will not pay for any expenses incurred for care or treatment of a Pre-existing Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if you applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy you had at least six (6) months of prior creditable coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If you had less than six (6) months prior creditable coverage, the pre-existing conditions limitation will be reduced by the aggregate amount of creditable coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a Physician within six (6) months prior to the policy effective date.